Let me tell you what PBMs do

Multibillion-dollar pharmacy benefit management companies are advertising aggressively to try to convince Congress and the Federal Trade Commission to approve a merger between Express Scripts and Medco Health Solutions (“PCMA launches advertising campaign,” Drug Store News, Jan. 17).


The Pharmaceutical Care Management Association ad campaign claims PBMs lower prescription drug costs for workers, employers and seniors, and reduce medication errors. Laughably, it claims PBMs will save plan sponsors and consumers nearly $2 trillion over the next 10 years. As proof of these claims, the ad campaign cites conclusions of a study by Visante that was prepared for the PCMA, the trade group for the PBMs, which is a bit like a defendant hiring his own expert witness.


As a community pharmacist and elected official, I have a different take on the PBMs than the misleading “That’s What PBMs Do” campaign, and strongly oppose the merger between ESI and Medco.


So, let me tell you what PBMs do, from my perspective. PBMs profit at the expense of consumers. These are for-profit companies that function as intermediaries between health plans, drug companies, retail pharmacies and patients. Their motive is profit, not patient care. The three largest PBMs, including ESI and Medco, have seen their profits nearly quadruple in the last three years — from $900 million to more than $3.5 billion — while most Americans have struggled through a tough recession. While profit is not necessarily a bad thing, it is legitimate to ask whether this tremendous escalation in profit has come at the expense of consumers, who have not seen a commensurate drop in the prices they pay for prescription drugs.


PBMs eliminate competition from smaller pharmacies. As PBMs exert increasing control over the prescription benefits of some 210 million Americans, they squeeze community pharmacists by under-reimbursing us for filling prescriptions. The larger the PBMs grow, the more negotiating power they have to eliminate any opportunity for community pharmacies to make a profit or simply break even.


The PBMs have a strong and unfair profit incentive to eliminate competition from retail pharmacies because they operate their own mail-order pharmacies. An ESI-Medco merger would give the combined company even more power to drive out the competition, forcing community pharmacies to lay off workers — or worse, close their doors altogether.


PBMs reduce prescription drug and pharmacy choices for consumers. The PBMs are empowered by health plans to decide which drugs are included on a particular formulary, so patients cannot always access their preferred brand-name or generic drug. PBMs also decide which pharmacies participate in their network. Sometimes they require that patients only buy from certain chain stores, cutting out other options completely. And increasingly, PBMs are requiring that patients order some drugs exclusively by mail, regardless of patient choice.


PBMs come between a person and his or her health provider of choice, if the provider is a pharmacist. By driving out competition from small pharmacies, restricting a patient’s choice of pharmacies and requiring people to use mail order, the PBMs are gradually making it impossible for people to benefit from the personalized attention of a pharmacist. PBM proponents characterize community pharmacists as unnecessary relics of the past. Medco CEO David Snow described his company’s pharmacy “robots” as more accurate than human pharmacists.


From the interactions I enjoy with my patients, I have drawn the opposite conclusion. Community pharmacists are more important now than ever, and still critical to the well-being of patients. By knowing our customers, we are able to anticipate and meet many of their needs, which is impossible for mail-order pharmacies. We counsel customers and work with them to ensure that they adhere to their doctors’ medication instructions and achieve maximum benefit from their medications.


Community pharmacists also provide such additional health services as vaccinations, health screenings and wellness programs that were once available only through a doctor’s office. This has enabled people who might not otherwise have access to these important preventive services to obtain them. These factors were left out of the self-serving PCMA analysis, but should be considered by Congress and the FTC as they continue to evaluate the merger. 


Evan Vickers is an independent pharmacist from Cedar City, Utah, and a member of the Utah House of Representatives.